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Understanding the inner life of people with dementia can be challenging and there is aneed for new and dierent approaches. Previous research shows that people with dementia canexperience emotions such as harmony, closeness, and joy as well as sadness and concern wheninteracting with a therapy dog. Simultaneously, memories of past episodes are brought back to lifewhen the person interacts with the dog. This raises questions about whether photos of interactionwith a dog can evoke memories or support people with dementia in communicating emotions in acorresponding way. The aim of this study was to explore photo-elicited conversations as a tool forengagement and communication in dementia care. Repeated video observations of photo-elicitedconversations between a woman with dementia and a dog handler/assistant nurse were used tocollect data. The video recordings were analyzed with a phenomenological hermeneutical method.The role of photo-elicited conversations as a tool for engagement and communication in dementiacare is that the conversations can help the person with dementia to feel a sense of being situatedand recall feelings of liveliness and belongingness, and thus supporting the person’s sense of self.The results can be used to deepen nursing sta’s understanding of using photo-elicited conversationsin dementia care.

Background: Clinical pathways can enhance care quality, promote patient safety and optimize resource utilization. However, they are infrequently utilized in intensive care. This study aimed to explain the implementation process of a clinical pathway based on a bottom-up approach in an intensive care context.

Methods: The setting was an 11-bed general intensive care unit in Sweden. An action research project was conducted to implement a clinical pathway for patients on mechanical ventilation. The project was managed by a local interprofessional core group and was externally facilitated by two researchers. Grounded theory was used by the researchers to explain the implementation process. The sampling in the study was purposeful and theoretical and included registered nurses (n31), assistant nurses (n26), anesthesiologists (n11), a physiotherapist (n1), first- and second-line managers (n2), and health records from patients on mechanical ventilation (n136). Data were collected from 2011 to 2016 through questionnaires, repeated focus groups, individual interviews, logbooks/field notes and health records. Constant comparative analysis was conducted, including both qualitative data and descriptive statistics from the quantitative data.

Results: A conceptual model of the clinical pathway implementation process emerged, and a central phenomenon, which was conceptualized as 'Struggling for a feasible tool,' was the core category that linked all categories. The phenomenon evolved from the 'Triggers' ('Perceiving suboptimal practice' and 'Receiving external inspiration and support'), pervaded the 'Implementation process' ('Contextual circumstances,' 'Processual circumstances' and 'Negotiating to achieve progress'), and led to the process 'Output' ('Varying utilization' and 'Improvements in understanding and practice'). The categories included both facilitating and impeding factors that made the implementation process tentative and prolonged but also educational.

Conclusions: The findings provide a novel understanding of a bottom-up implementation of a clinical pathway in an intensive care context. Despite resonating well with existing implementation frameworks/theories, the conceptual model further illuminates the complex interaction between different circumstances and negotiations and how this interplay has consequences for the implementation process and output. The findings advocate a bottom-up approach but also emphasize the need for strategic priority, interprofessional participation, skilled facilitators and further collaboration.

Purpose: The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure. Methods: This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses. Results: For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating. Conclusions: Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.Implications for Rehabilitation

• A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce.

• Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals.

• Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.

Background: Little is known about sick leave and the ability to return to work (RTW) for people with heart failure (HF). Previous research findings raise questions about the significance of encounters with social insurance officers (SIOs) and sociodemographics in people sick-listed due to HF. Aims: To investigate how people on sick leave due to HF experience encounters with SIOs and associations between sociodemographic factors, experiences of positive/negative encounters with SIOs, and self-estimated ability to RTW. Methods: This was a population-based study with a cross-sectional design. The sample consisted of 590 sick-listed people with HF in Sweden. A register-based investigation supplemented with a postal survey questionnaire was conducted. Bivariate correlations and logistic regression analysis was used to test associations between sociodemographic factors, positive and negative encounters, and self-estimated ability to RTW. Results: People with low income were more likely to receive sickness compensation. A majority of the responders experienced encounters with SIOs as positive. Being married was significantly associated with positive encounters. Having a low income was related to negative encounters. More than a third of the responders agreed that positive encounters with SIOs facilitated self-estimated ability to RTW. High income was strongly associated with the impact of positive encounters on self-estimated ability to RTW. Conclusion: Encounters between SIOs and people on sick leave due to HF need to be characterized by a person-centred approach including confidence and trust. People with low income need special attention.

BACKGROUND: People with heart failure are sick listed for long periods and disability pension is common. Healthcare professionals need knowledge about factors that can enhance their return to work processes.

AIMS: This study focus on people on sick leave due to heart failure and their encounters with healthcare professionals/social insurance officers. Specifically, it aimed to investigate associations between: (1) encounters and socio-demographic factors and, (2) encounters and self-rated ability to return to work.

MATERIAL AND METHODS: A cross-sectional study based on registry data and a postal questionnaire to people on sick leave due to heart failure (n = 590). Bivariate correlation analyses and logistic regression analyses were used.

RESULTS: Gender, income, and age were strongly associated with encounters with both social insurance officers and healthcare professionals. Self-rated ability to return to work was associated with the encounters 'Made reasonable demands', 'Gave clear and adequate information/advice' and 'Did not keep our agreements'.

CONCLUSION AND SIGNIFICANCE: To enhance clients' abilities to return to work demands should be reasonable, information and advice need to be clear, and agreements should be kept. These results can be used by healthcare professionals as occupational therapists involved in vocational rehabilitation for people on sick leave due to heart failure.

Nonnative English-speaking scholars and trainees are increasingly submitting their work to English journals. The study’s aim was to describe their experiences regarding scientific writing in English using a qualitative phenomenographic approach. Two focus groups (5 doctoral supervisors and 13 students) were conducted. Participants were nonnative English-speakers in a Swedish health sciences faculty. Group discussion focused on scientific writing in English, specifically, rewards, challenges, facilitators, and barriers. Participants were asked about their needs for related educational supports. Inductive phenomenographic analysis included extraction of referential (phenomenon as a whole) and structural (phenomenon parts) aspects of the transcription data. Doctoral supervisors and students viewed English scientific writing as challenging but worthwhile. Both groups viewed mastering English scientific writing as necessary but each struggles with the process differently. Supervisors viewed it as a long-term professional responsibility (generating knowledge, networking, and promotion eligibility). Alternatively, doctoral students viewed its importance in the short term (learning publication skills). Both groups acknowledged they would benefit from personalized feedback on writing style/format, but in distinct ways. Nonnative English-speaking doctoral supervisors and students in Sweden may benefit from on-going writing educational supports. Editors/reviewers need to increase awareness of the challenges of international contributors and maximize the formative constructiveness of their reviews.

Aims and objective. The aim of this study was to describe and interpret the essential meaning of the lived experiences of being in a critical illness-recovery process after a life-threatening condition. 

Background. The critical illness-recovery process after a life-threatening condition takes several years and does not only include patients' experiences during intensive care. Previous research has mainly focused on what critically ill patients recall. However, from a phenomenological point of view, experiences are more than memories alone. To plan and perform relevant health care and social support for patients who have survived a life-threatening condition, a more profound understanding about their lived experiences is needed. 

Design and method. In this qualitative study, a phenomenological hermeneutical approach was used. Interviews were conducted with seven patients, two to four years after they had received care in an intensive care unit in Sweden. 

Results. The comprehensive understanding of the results shows that the critical illness-recovery process after a life-threatening condition means an existential struggle to reconcile with an unfamiliar body and with ordinary life. This can be understood as an 'unhomelikeness' implying a struggle to create meaning and coherence from scary and fragmented memories. The previous life projects, such as work and social life become unfamiliar when the patient's fragile and weak body is disobedient and brings on altered sensations. 

Conclusions. Patients who survive a life-threatening condition have an immense need for care and support during the entire critical illness-recoveryprocess, and also after the initial acute phase. They need a coherent understanding of what happened, and support to be able to perform their changed life projects. 

Relevance to clinical practice. Supporting and caring for patients' recovery from a life-threatening condition involves recognising the patients' struggle and responding to their existential concerns.

Younger people with heart failure often experience poor self-rated health. Furthermore, poor self-rated health is associated with long-term sick leave and disability pension. Socio-demographic factors affect the ability to return to work. However, little is known about people on sick leave due to heart failure. The aim of this study was to investigate associations between self-rated health, mood, socio-demographic factors, sick leave compensation, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work, for people on sick leave due to heart failure. This population-based investigation had a cross-sectional design. Data were collected in Sweden in 2012 from two official registries and from a postal questionnaire. In total, 590 subjects, aged 23-67, responded (response rate 45.8%). Descriptive statistics, correlation analyses (Spearman bivariate analysis) and logistic regression analyses were used to investigate associations. Poor self-rated health was strongly associated with full sick leave compensation (OR = 4.1, p < .001). Compared self-rated health was moderately associated with low income (OR = 2.6, p = .003). Good self-rated health was strongly associated with positive encounters with healthcare professionals (OR = 3.0, p = .022) and to the impact of positive encounters with healthcare professionals on self-estimated ability to return to work (OR = 3.3, p < .001). People with heart failure are sicklisted for long periods of time and to a great extent receive disability pension. Not being able to work imposes reduced quality of life. Positive encounters with healthcare professionals and social insurance officers can be supportive when people with heart failure struggle to remain in working life.